OPTIC ATROPHY

AVANI T
ROLL NO. 8
 DEFINITION

 Degeneration of the optic nerve, which

occurs as an end result of any pathological
process that damages axons in anterior
visual field
 CLASSIFICATION

 Primary vs secondary
 Primary optic atrophy: Simple degeneration of nerve
fibres without any complicating process within eye
Eg- Syphilitic optic atrophy of tabes dorsalis
 Secondary optic atrophy: Occurs following any
pathological process which produces optic neuritis or
papilloedema
 Ophthalmic classification
 Primary (simple)
 Consecutive
 Glaucomatous
 Post-neuritic
 Vascular (ischaemic)
 Ascending vs descending optic atrophy
 Ascending or autograde optic atrophy (Wallerian
degeneration): Follows damage to ganglion cells due
to diseases of retina or optic disc. Degeneration
progresses from eyeball to the geniculate body
 Descending (retrograde) optic atrophy: Proceeds from
optic tract, chiasma or posterior part of optic nerve.
OPTIC PATHWAY
 PATHOLOGICAL FEATURES

 Degeneration is associated with attempted but

unsuccessful regeneration characterised by
proliferation of astrocytes and glial cells
 Depending on degree of loss of nerve tissue (gliosis), 3
situations may occur:
1. Degeneration associated with excessive gliosis: In
consecutive and postneuritic optic atrophy
2.Degeneration and gliosis may be orderly:
Proliferating astrocytes arrange themselves in
longitudinal columns (columnar gliosis). Eg, primary
optic atrophy

3.Degenration associated with negligible gliosis: Due

to progressive decrease in blood supply-
Cavernous(Schnabel’s) optic atrophy. Eg, glaucomatous
and ischaemic optic atrophy
 ETIOLOGY

1. Primary (simple): Lesions proximal to optic disc without

antecedent papilloedema
Eg- multiple sclerosis, retrobulbar neuritis, intracranial
tumours like pituitary tumour, trauma to optic nerve, toxic
ambylopias, tabes dorsalis
2. Consecutive: Follows destruction of destruction of
ganglion cells secondary to degenerative or inflammatory
lesions of choroid or retina, eg, diffuse chorioretinitis,
retinal pigmentary dystrophies, pathological myopia, CRAO
3. Post-neuritic: Develops as sequelae to long standing
papilloedema or papillitis
4. Glaucomatous: Effect of long-standing raised IOP
5. Vascular (ischaemic): Due to conditions other than
glaucoma which cause disc ischaemia. Eg, giant cell
arteritis, severe haemorrhage, severe anaemia &
quinine poisoning
 CLINICAL FEATURES

1. Loss of vision: Sudden or gradual onset, partial or

total
2. Pupil : Semidilated, direct light reflex sluggish or
absent, Marcus Gunn pupil
3. Visual field loss: Peripheral in systemic infections
central in focal optic neuritis and eccentric in nerve
or tract compression.
 Ophthalmicappearance: Pallor of disc, decrease in
number of small blood vessels
 Glaucomatous OA: Deep and wide cupping of optic
disc, nasal shift of blood vessel
 Ischaemic OA: Pallor of optic disc, Marked attenuation
of vessels
 DIFFERENTIAL DIAGNOSIS

 Other causes of pale optic disc:

i. Non-pathological causes: Axial myopia,
infants, elderly people with sclerotic
ii. Pathological causes: hypoplasia,
congenital pit, coloboma
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